As the season is over, several Bills players are slated for surgical procedures to address injuries sustained during the season. Kelvin Benjamin is one of them.
The 4th year WR’s partial meniscectomy has been long expected following his Week 11 injury against the Chargers. Benjamin had to miss several games following the injury but was able to return to play through the final stretch of the season, becoming a buoying presence for the wide receiver corps, helping the Bills to the playoffs. Today’s post will briefly review what a meniscus tear consists of, mechanisms of injury, and the surgical procedure and rehab that generally speaking is required to return to full health. For a greater detailed description of the meniscus and its role in knee movement, please reference my previous article.
The meniscus lies over the tibia and acts as a shock absorber between the tibia and femur. It is made up two wedge shaped areas that assist in deepening the area that the femur articulates with the tibia. During meniscus tears, a rotational force is applied to the area while the knee is bent resulting in a shearing motion, causing a portion of the meniscus to tear. There are many types and degrees of meniscus tears that could occur which include complete or partial, horizontal or vertical, longitudinal or transverse.
Symptoms of meniscal tears typically consist of pain, tenderness, and swelling, locking or clicking during knee movement, and initial difficulty in placing weight through the knee. Meniscal tears are typically seen in conjunction with MCL sprains/tears and ACL tears due to the rotational forces through the knee during impact. The size and location of the tear can vary, which determines the most effective course of treatment.
Thankfully, Benjamin only requires a partial meniscectomy which is typically a 4-6 week recovery to return to baseline. During a partial meniscectomy, an orthopedic surgeon goes in arthroscopically via two small holes in the knee. Once inside, the surgeon inserts a camera to observe the affected areas. From there, other tools are introduced to grab at the offending area and cut out the frayed portion of the meniscus. A shaver is introduced to smooth down the area to remodel and prevent any any future fraying or breakdown of the tissue.
After the surgical procedure is completed, rehab is introduced to restore the knee to full function. Immediately after any surgery, the body enters an inflammatory phase which can last up to 48 hours after the insult to the area. Typically pain and swelling are addressed first through the time tested RICE method. This includes rest, ice, compression, and elevation. This helps alleviate post surgical swelling and pain as if the leg is in a dependent position, the excess fluid builds up in the knee and lower leg, causing extra pressure on the surrounding tissues. Other ways to manage the pain include the use of a TENS unit which provide superficial electrical stimulation over the skin to assist in desensitizing the area to reduce pain.
Once pain and swelling have improved, range of motion and strengthening is implemented to focus on returning the knee to normal function. Range of motion exercises include alternating between bending and straightening the knee through stretching to normalize function. This can be accomplished through heel slides in lying or sitting, stretching with the use of a towel or belt to pull the knee into flexion, or assistance from a physical therapist through passive motion to increase range.
There are countless strengthening exercises that can be performed but simple exercises after surgery include quad sets which encourage knee straightening, short arc quads to improve quadriceps strength, hip flexion, abduction, and adduction strengthening for weight bearing and return to walking, and ankle pumps. Progression of strengthening include closed chain exercises which are where the foot is in contact with the ground include stationary bike, modified lunges, terminal knee extension, squats, etc. Further exercises included open chain exercises in where the foot is off the floor includes long arc quads, step ups, balance and proprioceptive exercises as knee function improves. Finally, running, cutting, plyometric activities are incorporated to increase towards return to sport. A general rehab protocol can be found here. Successful outcomes as high as 90% are reported and able to return to pre-injury level of activity.
Benjamin will return to full function without any complications barring infection in time for OTA’s. He will most likely work with medical staff to return to game form which will take several months. This is possibly why he did not have surgery during the season. With Benjamin’s previous history of knee injuries which include an ACL tear, knee sprain, and most recently, a meniscus tear, there is some concern for future injury. However, while he is at higher risk for injury due to the previous ACL tear, there is little evidence that I have found that supports increased risk of re-tearing the meniscus greater than normal rates.
As with other injuries, there is only so much that can be done for prevention. Strengthening, agility, and proprioceptive activities are key to reduce future injury. In the case of Benjamin’s injury, external forces through the joints can not be entirely prevented. Benjamin may be wearing a brace as he returns to his prior form to control any swelling. He may elect to play with a hard brace to prevent hyperextension, though this would reduce mobility leading to him declining this option.
Over the years, the Bills have witnessed rashes of injury, and the teams success this season in successfully rehabbing players like Kelvin very much assisted in 2017’s outcome. The Bills are primed with draft picks, free agency cap space, and what appears to be an the ability to bring players back healthy. This will allow them to address other needs this off season rather than having to plan for the unknown in terms of the return of injured contributors from 2017. Continue to check back for with me for Bills injury news, reviews by position and draft pick injury analysis. Follow me on Twitter @kyletrimble88, thank you for reading and GO BILLS!!